Initial Resuscitation

Algorithm for Children

Systematic Screening for

SEPTIC
! Sepsis in Children
!
SEPSIS
Within 1 SHOCK SUSPECTED Within 3
hour of initial hours of initial
recognition of suspicion of
septic shock Expedited sepsis
diagnostic
Shock evaluation
develops

Diagnostic evaluation supports

sepsis-associated organ dysfunction

1 2 3 4 5
Obtain Collect Start empiric Measure Administer fluid Start vasoactive
IV/IO blood broad-spectrum lactate. bolus(es) if shock agents if shock
access. culture. antibiotics. is present.* persists.*

Respiratory support
Assess for Pediatric Acute Respiratory Distress Syndrome

Infectious source control Continuous Fluid and vasoactive titration*

reassessment

Advanced hemodynamic monitoring if shock persists

• +/- hydrocortisone • Avoid hypoglycemia VA or VV ECLS for refractory shock or

for refractory shock** • Antimicrobial oxygenation/ventilation failure (after addressing
• Nutritional support stewardship other causes of shock and respiratory failure)

*See fluid and vasoactive algorithm. Note: Fluid bolus should be omitted from bundle if a) fluid overload
is present or b) it is a low-resource setting without hypotension. Fluid in mL/kg should be dosed as ideal
body weight.
**Hydrocortisone may produce benefit or harm.

www.sccm.org/SurvivingSepsisCampaign/Guidelines/Pediatric-Patients
© 2020 the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. All Rights Reserved.
Fluid and Vasoactive-Inotrope
Management Algorithm For Children
Healthcare Systems
WITH Intensive Care
SEPTIC
! Healthcare Systems
WITHOUT Intensive Care

SHOCK

Abnormal Perfusion with Abnormal perfusion Abnormal perfusion

or without Hypotension WITHOUT WITH hypotension*
hypotension
• If signs of fluid overload • If signs of fluid overload
are absent, administer • Do NOT give fluid are absent, administer
fluid bolus, 10-20 mL/kg. bolus unless fluid bolus, 10-20 mL/kg.
• Repeat assessment of there are signs of • Assess hemodynamic
hemodynamic response dehydration with response to fluid and
to fluid and consider fluid ongoing fluid losses repeat fluid boluses, 10-20
boluses, 10-20 mL/kg, until (eg, diarrhea). mL/kg, until hypotension
shock resolves or signs of • Start maintenance resolves or signs of
fluid overload develop. fluids. fluid overload develop.
• Assess cardiac function. • Monitor • Assess cardiac
• Consider epinephrine hemodynamics function (if available)
if there is myocardial closely. • Consider epinephrine/
dysfunction or epinephrine/ • Consider vasoactive- norepinephrine if
norepinephrine if shock inotropic support hypotension persists
persists after 40-60 mL/ (if available). after 40 mL/kg or
kg (or sooner if signs of sooner if signs of fluid
fluid overload develop). overload develop.

Fluid in mL/kg should be dosed as ideal body weight.

Shock resolved, perfusion improved

• Do not give more • Consider • Monitor for signs/symptoms

fluid boluses. maintenance fluids. of recurrent shock.

*Hypotension SBP SBP SBP Presence of all 3 World

in healthcare < 50 mm Hg < 60 mm Hg < 70 mm Hg Health Organization criteria:
systems WITHOUT in children in children in children OR cold extremities, prolonged
intensive care is aged < 12 aged 1 to 5 aged > 5 capillary refill > 3 seconds,
defined as either: months years years weak/fast pulse

www.sccm.org/SurvivingSepsisCampaign/Guidelines/Pediatric-Patients
© 2020 the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. All Rights Reserved.